Clinical impact of collateral circulation in patients with median arcuate ligament syndrome

Heo, Subin; Kim, Hye Jin; Kim, Bohyun; Lee, Jei Hee; Kim, Jinoo; Kim, Jai Keun

doi:10.5152/dir.2018.17514

Cited by 50 publications

(54 citation statements)

References 23 publications

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“…The classic clinical manifestations of MALS include chronic postprandial epigastric pain, nausea, and loss of weight due to dynamic compression of the celiac artery [1]. However, this anatomical anomaly is asymptomatic in up to 85% of patients and may be incidentally encountered on CT examinations performed for unrelated reasons [1,5,6]. The mechanism of pain is still debated.…”

Section: Median Arcuate Ligament Syndromementioning

confidence: 99%

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CT imaging findings of abdominopelvic vascular compression syndromes: what the radiologist needs to know

et al. 2020

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Abdominopelvic vascular compression syndromes include a variety of uncommon conditions characterized by either extrinsic compression of blood vessels by adjacent anatomical structures (i.e., median arcuate ligament syndrome, nutcracker syndrome, May-Thurner syndrome) or compression of hollow viscera by adjacent vessels (i.e., superior mesenteric artery syndrome, ureteropelvic junction obstruction, ureteral vascular compression syndromes, portal biliopathy). These syndromes can be unexpectedly diagnosed even in asymptomatic patients and the predisposing anatomic conditions can be incidentally discovered on imaging examinations performed for other indications, or they can manifest with atypical abdominal symptoms and acute complications, which may lead to significant morbidity if unrecognized. Although computed tomography (CT) is an accurate noninvasive technique for their detection, the diagnosis remains challenging due to the uncommon clinical presentation and often overlooked imaging features. Dynamic imaging may be performed in order to evaluate patients with inconstant symptoms manifesting in a specific position. The purposes of this paper are to review the CT imaging findings of abdominopelvic vascular compression syndromes, correlating with anatomical variants and to provide key features for the noninvasive imaging diagnosis.

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Section: Median Arcuate Ligament Syndromementioning

confidence: 99%

“…Epigastric pain may be also related to celiac plexus nerve compression [7]. The development of collateral circulation through the pancreaticoduodenal arcades prevents chronic hypoperfusion in patients with severe stenosis of the celiac artery [6].…”

Section: Median Arcuate Ligament Syndromementioning

confidence: 99%

CT imaging findings of abdominopelvic vascular compression syndromes: what the radiologist needs to know

et al. 2020

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“…Celiac trunk obstruction can result in hemodynamic flow changes proportionate to the degree of occlusion, leading to complications like splanchnic artery aneurysms [8,10]. Any resulting aneurysm requires strict follow up and/or surgical intervention via endovascular approach in conjunction with celiac artery decompression [8].…”

Section: Discussionmentioning

confidence: 99%

“…Prolonged compression results in vasculature changes like intimal hyperplasia, elastic fiber proliferation in media, and disorganization of adventitia [1]. Marked celiac trunk obstruction is predestined to form collaterals to maintain the survival of organs supplied by its branches [10]. Collaterals play a role in preventing foregut ischemic pain, which in turn is responsible for the rarity of MALS clinical presentation [10].…”

Section: Discussionmentioning

confidence: 99%

An Atypical Presentation of Median Arcuate Ligament Syndrome

Rawala

Ahmed

Rizvi

2020

Cureus

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“…However, CAS is often asymptomatic due to the formation of collateral blood flow from surrounding arteries [2]. In many cases, the gastroduodenal artery (GDA) is a main collateral pathway from the superior mesenteric artery (SMA) to the CA system through common hepatic artery (CHA) [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Arterial communication around the pancreatic tail enabled division of the gastroduodenal artery during pancreaticoduodenectomy in patient with complete celiac artery occlusion: a case report

et al. 2020

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Background: Stenosis or obstruction of the celiac artery (CA) is known as celiac artery stenosis (CAS) and is usually accompanied by the formation of arterial anastomosis between the superior mesenteric artery (SMA) system and the CA system. Arterial bypass is mainly achieved through the gastroduodenal artery (GDA); therefore, the division of the GDA during pancreaticoduodenectomy (PD) could pose a problem in patients with CAS. Case presentation: We reported a case of PD presenting complete occlusion of the CA, in which perfusion to organs in the CA system was maintained via peri-pancreatic arterial communication. There were complicated arterial anastomoses around the pancreas, which were clearly visualized on a three-dimensional reconstruction of the arterial system using multi-detector computed tomography. Among these complicated anastomoses, one welldeveloped anastomosis between the SMA and the splenic artery through the dorsal pancreatic artery (DPA) was identified. The DPA was considered to work as a potential collateral pathway from the SMA to organs in the CA system after division of the GDA. During surgery, Doppler ultrasonography detected hepatopetal arterial flow even after the GDA clamping; therefore, we performed typical PD with division of the GDA. The postoperative course of the patient was uneventful, and there was no sign of ischemic complications in the CA system organs including the liver, stomach or spleen. Conclusions: Three-dimensional reconstruction of the arterial system using multi-detector computed tomography and the intraoperative GDA clamping test were useful to determine whether it was possible to divide the GDA in PD, in the case of CAS.

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Clinical impact of collateral circulation in patients with median arcuate ligament syndrome

Cited by 50 publications

References 23 publications

CT imaging findings of abdominopelvic vascular compression syndromes: what the radiologist needs to know

CT imaging findings of abdominopelvic vascular compression syndromes: what the radiologist needs to know

An Atypical Presentation of Median Arcuate Ligament Syndrome

Arterial communication around the pancreatic tail enabled division of the gastroduodenal artery during pancreaticoduodenectomy in patient with complete celiac artery occlusion: a case report

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